2型糖尿病并发骨质疏松的影响因素及血清AKT、GSK-3β水平与骨密度的相关性

Influencing factors of osteoporosis in patients with type 2 diabetes mellitus and the correlation of serum AKT and GSK-3β levels with bone mineral density

摘要

目的：分析2型糖尿病(T2DM)骨质疏松患者血清蛋白激酶B（AKT）、糖原合成酶激酶-3β（GSK-3β）水平与骨密度及骨质疏松影响因素的相关性，并评价血清AKT、GSK-3β水平对2型糖尿病并发骨质疏松的评估价值。方法：将2023年10月—2024年10月潜江市中心医院收治的120例2型糖尿病患者依据是否并发骨质疏松分为骨质疏松组（n=48）与非骨质疏松组（n=72）。测定所有研究对象的血清AKT、GSK-3β水平及骨密度，以Logistic回归分析2型糖尿病并发骨质疏松的影响因素，以Pearson相关分析血清AKT、GSK-3β水平与骨密度及影响因素的相关性，以受试者工作特征（ROC）曲线分析AKT、GSK-3β水平对骨质疏松的评估价值。结果：相比于非骨质疏松组，骨质疏松组的血清AKT、总Ⅰ型胶原端延长肽（T-PINP）、骨钙素（BGP）水平及骨密度更低，血清GSK-3β、Ⅰ型胶原羧基端肽β特殊序列（β-CTX）水平更高（t=4.148，3.168，4.409，4.049，2.820，4.361，P<0.05）；Logistic回归分析显示，血清AKT、T-PINP、BGP水平及骨密度是2型糖尿病并发骨质疏松的保护因素，血清GSK-3β、β-CTX水平是其危险因素（OR：0.510，95%CI：0.354~0.734；OR：0.636，95%CI：0.424~0.955；OR：0.605，95%CI：0.372~0.983；OR：0.619，95%CI：0.417~0.920；OR：1.372，95%CI：1.110~1.695；OR：1.525，95%CI：1.016~2.288，P<0.05）。相关性分析显示，血清AKT水平与骨密度、T-PINP、BGP水平呈正相关，与β-CTX水平呈负相关（r=0.328，0.277，0.359，-0.341，P<0.05）；血清GSK-3β水平与骨密度、T-PINP、BGP水平呈负相关，与β-CTX水平呈正相关（r=-0.309，-0.206，-0.342，0.325，P<0.05）。ROC曲线显示，血清AKT、GSK-3β联合评估2型糖尿病并发骨质疏松的ROC曲线下面积为0.882，灵敏度为95.83%，特异度为69.44%，评估效能明显优于各指标单独评估（P<0.05）。结论：2型糖尿病骨质疏松患者血清AKT、GSK-3β水平与骨密度密切相关。

Abstract

Objective: To analyze the correlation of serum protein kinase B (AKT) and glycogen synthase kinase-3β (GSK-3β) levels with bone mineral density and influencing factors of osteoporosis in patients with type 2 diabetes mellitus (T2DM), and to assess the evaluation value of serum AKT and GSK-3β levels on T2DM with osteoporosis. Methods: A total of 120 patients with T2DM admitted to Qianjiang Central Hospital from October 2023 to October 2024 were enrolled and divided into the osteoporosis group (n=48) and the non-osteoporosis group (n=72) according to the presence or absence of osteoporosis. Serum levels of AKT and GSK-3β, as well as bone mineral density (BMD), were measured in all participants. Logistic regression analysis was used to identify factors associated with osteoporosis in T2DM. Pearson correlation analysis was performed to assess correlations among AKT, GSK-3β, BMD, and the identified risk factors. Receiver operating characteristic (ROC) curves were constructed to evaluate the diagnostic performance of AKT and GSK-3β for osteoporosis. Results: Compared with the non-osteoporosis group, the levels of serum AKT, total procollagen type Ⅰ N-terminal propeptide (T-PINP), bone gla protein (BGP) and BMD in the osteoporosis group were decreased while the levels of serum GSK-3β and β-C-terminal telopeptide of type Ⅰ collagen (β-CTX) were increased (t=4.148, 3.168, 4.409, 4.049, 2.820, 4.361, P<0.05). Logistic regression analysis indicated that serum AKT, T-PINP, BGP, and BMD were protective factors of osteoporosis, and serum GSK-3β and β-CTX levels were risk factors (OR: 0.510, 95%CI: 0.354-0.734; OR: 0.636, 95%CI: 0.424-0.955; OR: 0.605, 95%CI: 0.372-0.983; OR: 0.619, 95%CI: 0.417-0.920; OR: 1.372, 95%CI: 1.110-1.695; OR: 1.525, 95%CI: 1.016-2.288, P<0.05). Correlation analysis revealed that serum AKT level was positively correlated with BMD, T-PINP and BGP, and negatively associated with β-CTX level (r=0.328, 0.277, 0.359, -0.341, P<0.05). Serum GSK-3β level was inversely related to BMD, T-PINP and BGP, and was positively related to β-CTX level (r=-0.309, -0.206, -0.342, 0.325, P<0.05). ROC curve suggested that the area under the curve (AUC), sensitivity and specificity of serum AKT combined with GSK-3β in evaluating T2DM with osteoporosis were 0.882, 95.83%, and 69.44%. The evaluation efficiency was significantly superior to that of any single indicator (P<0.05). Conclusion: In T2DM patients with osteoporosis, serum AKT and GSK-3β levels are strongly correlated with bone mineral density.

关键词

骨质疏松 / 2型糖尿病 / 蛋白激酶B / 糖原合成酶激酶-3β / 骨密度 / 相关性

Key words

Osteoporosis / Type 2 Diabetes Mellitus / Protein Kinase B / Glycogen Synthase Kinase-3β / Bone Mineral Density / Correlation

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基金资助

湖北省中医药科研项目(ZY2025L084)